A Clinical Study of Post-Traumatic Amnesia

1971 ◽  
Vol 16 (4) ◽  
pp. 341-346
Author(s):  
O. Schwartz ◽  
G. C. Sisler
Keyword(s):  
Head Injuries ◽  
Verbal Learning ◽  
Paired Associates ◽  
Immediate Recall ◽  
Criterion Score ◽  
Traumatic Amnesia ◽  
Initial Learning ◽  
Head Injured ◽  
Post Traumatic ◽  
Injured Patients

Fifteen consecutive patients with head injuries, admitted to the neurosurgical services of the Winnipeg General and St. Boniface hospitals, were given two memory tests within 24 hours following recovery of consciousness. The first test concerned immediate recall of a series of digits, presented orally. The second was a paired-associates test which involved learning and retaining pairs of stimuli and also required that when one stimulus of the pair is given the subjects correctly respond with the other associated stimulus. Fifteen control subjects admitted to hospital for acute episodes other than head injury were tested. The controls were matched with the head-injured subjects for age and education. During the eight-minute retention interval a distraction stimulus was administered randomly to six of the head-injured subjects and to six matched controls. No defect was found in immediate (a few seconds) memory of the head-injured group. The distracting stimulus had no significant influence on retention. Verbal learning, as defined by the number of trials to reach a criterion score on a memory test, was impaired and verbal retention, tested by recall at one hour after the initial learning period, was also impaired. These findings suggest that head-injured patients have at least a temporarily decreased ability to form lasting memory traces.

Verbal learning deficits following severe head injury: heterogeneity in recovery over 1 year

1991 ◽  
Vol 75 (Supplement) ◽  
pp. S50-S58 ◽  
Author(s):  
Ronald M. Ruff ◽  
David Young ◽  
Theresa Gautille ◽  
Lawrence F. Marshall ◽  
Jeff Barth ◽  
...  
Keyword(s):  
Memory Performance ◽  
Verbal Learning ◽  
Data Bank ◽  
Learning Deficits ◽  
Content Type ◽  
Recovery Curve ◽  
Recovery Curves ◽  
Head Injured ◽  
Injured Patients ◽  
Case Basis

✓ A total of 40 severely head-injured patients were selected from the Traumatic Coma Data Bank, supported by the National Institute of Neurological Disorders and Stroke, to analyze the recovery of verbal learning across baseline and 6- and 12-month evaluations postinjury. During the initial 6 months, the group demonstrated marked recovery, followed by an absence of improvement over the latter part of the year. Analysis of this recovery curve on a case by case basis revealed three recovery subtypes: namely, a flat curve, a peak-drop curve, or an improvement curve. These three subtypes proved to have concurrent validity when compared with another memory test. Adding 19 new patients to the sample cross-validated the subtypes. However, the memory performance of the 59 patients was dissociated from other neuropsychological tests which showed recovery at more equivalent rates across the subtypes. Analysis of the demographic and neurological characteristics disclosed that the group with a peak-drop recovery curve was less well educated and the group with a flat curve demonstrated a trend toward higher levels of hypoxia. Moreover, the three subgroups were rated by their relatives to have equivalent levels of depression at baseline and at 6 months, but only the improved subgroup demonstrated reduced depression at 1 year. The clinical relevancy of these differential recovery curves is discussed.

Prediction tree for severely head-injured patients

1991 ◽  
Vol 75 (2) ◽  
pp. 251-255 ◽  
Author(s):  
Sung C. Choi ◽  
Jan P. Muizelaar ◽  
Thomas Y. Barnes ◽  
Anthony Marmarou ◽  
Danny M. Brooks ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Predictive Accuracy ◽  
Head Injuries ◽  
Pupillary Response ◽  
Prognostic Indicators ◽  
Critical Threshold ◽  
Content Type ◽  
Intermediate Outcomes ◽  
Head Injured ◽  
Injured Patients

✓ Prediction tree techniques are employed in the analysis of data from 555 patients admitted to the Medical College of Virginia hospitals with severe head injuries. Twenty-three prognostic indicators are examined to predict the distribution of 12-month outcomes among the five Glasgow Outcome Scale categories. A tree diagram, illustrating the prognostic pattern, provides critical threshold levels that split the patients into subgroups with varying degrees of risk. It is a visually useful way to look at the prognosis of head-injured patients. In previous analyses addressing this prediction problem, the same set of prognostic factors (age, motor score, and pupillary response) was used for all patients. These approaches might be considered inflexible because more informative prediction may be achieved by somewhat different combinations of factors for different patients. Tree analysis reveals that the pattern of important prognostic factors differs among various patient subgroups, although the three previously mentioned factors are still of primary importance. For example, it is noted that information concerning intracerebral lesions is useful in predicting outcome for certain patients. The overall predictive accuracy of the tree technique for these data is 77.7%, which is somewhat higher than that obtained via standard prediction methods. The predictive accuracy is highest among patients who have a good recovery or die; it is lower for patients having intermediate outcomes.

Development of a Bayesian Network for the Prognosis of Head Injuries using Graphical Model Selection Techniques

1999 ◽  
Vol 38 (01) ◽  
pp. 37-42 ◽  
Author(s):  
G. C. Sakellaropoulos ◽  
G. C. Nikiforidis
Keyword(s):  
Model Selection ◽  
Bayesian Network ◽  
Analytical Approach ◽  
Graphical Model ◽  
Head Injuries ◽  
Sources Of Information ◽  
Laboratory Findings ◽  
Learning Techniques ◽  
Head Injured ◽  
Injured Patients

Abstract:The assessment of a head-injured patient’s prognosis is a task that involves the evaluation of diverse sources of information. In this study we propose an analytical approach, using a Bayesian Network (BN), of combining the available evidence. The BN’s structure and parameters are derived by learning techniques applied to a database (600 records) of seven clinical and laboratory findings. The BN produces quantitative estimations of the prognosis after 24 hours for head-injured patients in the outpatients department. Alternative models are compared and their performance is tested against the success rate of an expert neurosurgeon.

Physician Prehospital Care in Mexico City: Retrospective Analysis of Endotracheal Intubation in Patients with Severe Head Trauma

2020 ◽  
Vol 35 (2) ◽  
pp. 128-132
Author(s):  
J. Sebastián Espino-Núñez ◽  
Mirsha Quinto-Sánchez ◽  
Anabel C. Carrada-Varela ◽  
Fernando Román-Morales
Keyword(s):  
Retrospective Analysis ◽  
Endotracheal Intubation ◽  
Mexico City ◽  
Head Trauma ◽  
Prehospital Care ◽  
Head Injuries ◽  
Head Injured ◽  
Prehospital Diagnosis ◽  
Medical Emergencies ◽  
Injured Patients

AbstractIntroduction:In Mexico, physicians have become part of public service prehospital care. Head injured patients are a sensitive group that can benefit from early advanced measures to protect the airway, with the objective to reduce hypoxia and maintain normocapnia.Problem:The occurrence of endotracheal intubation to patients with severe head injuries by prehospital physicians working at Mexico City’s Service of Emergency Medical Care (SAMU) is unknown.Methods:A retrospective analysis of five-year data (2012-2016) from Mexico City’s Medical Emergencies Regulation Center was performed. Only SAMU ambulance services were analyzed. Adult patients with a prehospital diagnosis of head injury based on mechanism of injury and physical examination with a Glasgow Coma Scale (GCS) <nine were included.Results:A total of 293 cases met the inclusion criteria; the mean GCS was five points. Of those, 150 (51.1%) patients were intubated. There was no difference in the occurrence of intubation among the different GCS scales, or if the patient was considered to have isolated head trauma versus polytrauma. Fifteen patients were intubated using sedation and neuromuscular blockage. Four patients were intubated with sedation alone and six patients with neuromuscular blockage alone. One patient was intubated using opioid analgesia, sedation, and neuromuscular blockage.Conclusions:Patients with severe head injuries cared by prehospital physicians in Mexico City were intubated 51.1% of the time and were more likely to be intubated without the assistance of anesthetics.

Golf Related Head Injuries in Children: The Little Tigers

1998 ◽  
Vol 43 (5) ◽  
pp. 139-140 ◽  
Author(s):  
A.C. McGuffie ◽  
M.O. Fitzpatrick ◽  
D. Hall
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Emergency Departments ◽  
Head Injuries ◽  
Western Society ◽  
Accident And Emergency ◽  
Head Injured ◽  
Accident And Emergency Department ◽  
Injured Patients

Head injury is a major cause of morbidity in Western society and sport related incidents account for approximately 11% of all head injured patients attending Accident and Emergency Departments. 1 Golf was shown to be one of the sports most commonly associated with head injury requiring referral to a regional neurosurgical centre.2 Previous studies have demonstrated that it is predominantly children who sustain golf related head injuries which present either to an accident and emergency department3 or a regional neurosurgical centre.2 This study examines the number and pattern of golf related head injuries in children presenting to an accident and emergency department or requiring admission to the regional neurosurgical centre, over a three month period.

Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation

1996 ◽  
Vol 85 (5) ◽  
pp. 751-757 ◽  
Author(s):  
Karl L. Kiening ◽  
Andreas W. Unterberg ◽  
Tillman F. Bardt ◽  
Gerd-Helge Schneider ◽  
Wolfgang R. Lanksch
Keyword(s):  
Oxygen Saturation ◽  
Cerebral Oxygenation ◽  
Jugular Vein ◽  
Head Injuries ◽  
Jugular Bulb ◽  
Cerebral White Matter ◽  
Content Type ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Monitoring of cerebral oxygenation is considered to be of great importance in minimizing secondary hypoxic and ischemic brain damage following severe head injury. Although the threshold for cerebral hypoxia in jugular bulb oximetry (measurement of O2 saturation in the jugular vein (SjvO2)) is generally accepted to be 50% oxygen saturation, a comparable value in brain tissue PO2 (PtiO2) monitoring, a new method for direct assessment of PO2 in the cerebral white matter, has not yet been established. Hence, the purpose of this study was to compare brain PtiO2 with SjvO2 in severely head injured patients during phases of reduced cerebral perfusion pressure (CPP) to define a threshold in brain PtiO2 monitoring. In addition, the safety and data quality of both SjvO2 and brain PtiO2 monitoring were studied. In 15 patients with severe head injuries, SjvO2 and brain PtiO2 were monitored simultaneously. For brain PtiO2 monitoring a polarographic microcatheter was inserted in the frontal cerebral white matter, whereas for SjvO2 measurements were obtained by using a fiberoptic catheter placed in the jugular bulb. Intracranial pressure was monitored by means of an intraparenchymal catheter. Mean arterial blood pressure, CPP, end-tidal CO2, and arterial oxygen saturation (pulse oximetry) were continuously recorded. All data were simultaneously stored and analyzed using a multimodal computer system. For specific analysis, phases of marked deterioration in systemic blood pressure and consecutive reductions in CPP were investigated. There were no complications that could be attributed to the PtiO2 catheters, that is, no intracranial bleeding or infection. The “time of good data quality” was 95% in brain PtiO2 compared to 43% in SjvO2; PtiO2 monitoring could be performed twice as long as SjvO2 monitoring. During marked decreases in CPP, SjvO2 and brain PtiO2 correlated closely. A significant second-order regression curve of SjvO2 versus brain PtiO2 (p < 0.01) was plotted. At a threshold of 50% in SjvO2, brain PtiO2 was found to be within the range of 3 to 12 mm Hg, with a regression curve “best fit” value of 8.5 mm Hg. There was a close correlation between CPP and oxygenation parameters (PtiO2 and SjvO2) when CPP fell below a breakpoint of 60 mm Hg, suggesting intact cerebral autoregulation in most patients. This study demonstrates that monitoring brain PtiO2 is a safe, reliable, and sensitive diagnostic method to follow cerebral oxygenation. In comparison to SjvO2, PtiO2 is more suitable for long-term monitoring. It can be used to minimize episodes of secondary cerebral maloxygenation after severe head injury and may, hopefully, improve the outcome in severely head injured patients.

scholarly journals Effects of Overt and Silent Study on Recall of Visual Information by Head-Injured Patients

1986 ◽  
Vol 59 (1) ◽  
pp. 315-322 ◽  
Author(s):  
James A. Arnett ◽  
John D. Corrigan
Keyword(s):  
Visual Information ◽  
Compensatory Strategies ◽  
Memory Enhancement ◽  
Overt Rehearsal ◽  
Immediate Recall ◽  
Brain Injured ◽  
Head Injured ◽  
Main Effect ◽  
Traumatic Head ◽  
Injured Patients

A 2 × 2 factorial design was used to examine the immediate recall of traumatic head-injured and hospitalized controls under two conditions of study. Subjects recalled details from pictures that were either examined silently (silent study) or by naming details aloud (overt rehearsal). Analysis showed a significant interaction for type of study by type of subject, with head-injured subjects recalling more details using overt rehearsal while hospitalized controls recalled more using silent study. A main effect showing greater immediate recall for control subjects was also present. Results are discussed with regard to compensatory strategies for memory enhancement of brain-injured individuals.

A prospective study of children with head injuries: I. Design and methods

1980 ◽  
Vol 10 (4) ◽  
pp. 633-645 ◽  
Author(s):  
Michael Rutter ◽  
Oliver Chadwick ◽  
David Shaffer ◽  
Gillian Brown
Keyword(s):  
Head Injury ◽  
Prospective Study ◽  
Reading Ability ◽  
School Teacher ◽  
Head Injuries ◽  
Control Group ◽  
Physical Handicap ◽  
Traumatic Amnesia ◽  
Post Traumatic ◽  
A Prospective Study

SYNOPSISThe main unresolved issues with respect to the psychological sequelae of brain damage in childhood are noted, and the previous studies of children suffering head injury are critically reviewed. A new prospective study is described. Three groups of children were studied: (a) 31 children with ‘severe’ head injuries resulting in a post-traumatic amnesia of at least 7 days; (b) an individually matched control group of 28 children with hospital-treated orthopaedic injuries; and (c) 29 children with ‘mild’ head injuries resulting in a post-traumatic amnesia exceeding 1 hour but less than 1 week. The children were studied as soon as possible after the accident and then again 4 months, 1 year, and 2¼ years after the injury. The parents were interviewed, using systematic and standardized interview techniques; both parents and teachers completed behavioural questionnaires; and the children were seen for individual psychological testing using the WISC, the Neale Analysis of Reading Ability and a battery of tests of more specific cognitive functions. At the final follow-up, the severe head injury group (but not the other 2 groups) received a systematic neurological examination and the school teacher who knew the child best was personally interviewed. The findings are given on physical handicap, neurological abnormality, school placement and psychiatric referrals. All types of disabilities were both more frequent and more persistent in the children with severe head injuries.

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